Case 9 - Stress Fractures

Question 1

what is the examination for stress fractures

Answer 1

tenderness on palpation over fracture site
percussion of bone away from fracture may illicit pain
functional stressing of bone e.g hopping

look for clues to underlying condition

Question 2

what are the investigations used in stress fracture

Answer 2

plain X ray
bone scan - worried about several fractures
MRI
bloods

Question 3

what is the management for stress fractures

Answer 3

rest
Immobilisation
Avoid NSAIDs - can slow down bone healing
Get patient onboard
Treat underlying conditions

Question 4

what is pulsed ultrasound

Answer 4

thought to up regulate chondrocytes and increasing endochondral ossification or ESWL (extra corporeal shockwave therapy) induces periosteal detachment and microtrabecular fracture which stimulates fracture healing

Question 5

what is an indication for surgery on an X ray

Answer 5

black line on lateral x ray

Question 6

what does tibial nail with drilling do

Answer 6

hollow nails used and this increases bleeding which induces healing

Question 7

what is an ACL injury

Answer 7

non contact twisting injury
More common In female athletes 4.5:1
Pop in knee
Immediate swelling
Inability to continue with sport
Physiotherapy - main form of treatment
ACL reconstruction with hamstrings/quads or patella tendon: symptomatic instability of the knee, 2/3 only get physiotherapy. Will stabilise the knee but will not prevent against early onset osteoarthritis